Search results for: rural healthcare settings

Authors: Chuan-Ming Tung, Jin-Cheng Fu, Chia-En Feng

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In recent years, the rapid development of urban land in Taiwan has led to the constant increase of the areas of impervious surface, which has increased the risk of waterlogging during heavy rainfall. Therefore, in recent years, promoting runoff allocation responsibilities has often been used as a means of reducing regional flooding. In this study, the single catchment area covering both urban and rural land as the study area is discussed. Based on Storm Water Management Model, urban and rural land in a single catchment area was explored to develop the runoff allocation responsibilities according to their respective control regulation on land use. The impacts of runoff increment and reduction in sub-catchment area were studied to understand the impact of highly developed urban land on the reduction of flood risk of rural land at the back end. The results showed that the rainfall with 1 hour short delay of 2 years, 5 years, 10 years, and 25 years return period. If the study area was fully developed, the peak discharge at the outlet would increase by 24.46% -22.97% without runoff allocation responsibilities. The front-end urban land would increase runoff from back-end of rural land by 76.19% -46.51%. However, if runoff allocation responsibilities were carried out in the study area, the peak discharge could be reduced by 58.38-63.08%, which could make the front-end to reduce 54.05% -23.81% of the peak flow to the back-end. In addition, the researchers found that if it was seen from the perspective of runoff allocation responsibilities of per unit area, the residential area of urban land would benefit from the relevant laws and regulations of the urban system, which would have a better effect of reducing flood than the residential land in rural land. For rural land, the development scale of residential land was generally small, which made the effect of flood reduction better than that of industrial land. Agricultural land requires a large area of land, resulting in the lowest share of the flow per unit area. From the point of the planners, this study suggests that for the rural land around the city, its responsibility should be assigned to share the runoff. And setting up rain water storage facilities in the same way as urban land, can also take stock of agricultural land resources to increase the ridge of field for flood storage, in order to improve regional disaster reduction capacity and resilience.

Keywords: runoff allocation responsibilities, land use, flood mitigation, SWMM

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Authors: Shamima Akhter, Siegfried Bauer

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The aim of this study is to analyze the migration process of the rural population of Bangladesh. Heckman Probit model with sample selection was applied in this paper to explore the determinants of migration and intensity of migration at farm household level. The farm survey was conducted in the central part of Bangladesh on 160 farm households with migrant and on 154 farm households without migrant including a total of 316 farm households. The results from the applied model revealed that main determinants of migration at farm household level are household age, economically active males and females, number of young and old dependent members in the household and agricultural land holding. On the other hand, the main determinants of intensity of migration are availability of economically adult male in the household, number of young dependents and agricultural land holding.

Keywords: determinants, Heckman Probit model, migration, rural-urban

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Authors: Nkeiruka Elsie Ezomike, Chinwe L. Onyekonwu, Anthony N. Ikefuna, Bede C. Ibe

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Superficial fungal infections (SFIs) are one of the common cutaneous infections that affect children worldwide. They may lead to school absenteeism or school drop-out and hence setback in the education of the child. Community-based studies in any locality are good reflections of the health conditions within that area. There is a dearth of information in the literature about SFI among primary school children in Enugu. This study aimed to determine the clinicomycological pattern of SFIs among primary school children in rural and urban communities in Enugu. This was a comparative descriptive cross-sectional study among primary school children in Awgu (rural) and Enugu North (urban) Local Government Areas (LGAs). Subjects' selection was made over 6 months using a multi-stage sampling method. Information such as age, sex, parental education, and occupation were collected using questionnaires. Socioeconomic classes of the children were determined using the classification proposed by Oyedeji et al. The samples were collected from subjects with SFIs. Potassium hydroxide tests were done on the samples. The samples that tested positive were cultured for SFI by inoculating onto Sabouraud's dextrose chloramphenicol actidione agar. The characteristics of the isolates were identified according to their morphological features using Mycology Online, Atlas 2000, and Mycology Review 2003. Equal numbers of children were recruited from the two LGAs. A total of 1662 pupils were studied. The mean ages of the study subjects were 9.03 ± 2.10years in rural and 10.46 ± 2.33years in urban communities. The male to female ratio was 1.6:1 in rural and 1:1.1 in urban communities. The personal hygiene of the children was significantly related to the presence of SFIs. The overall prevalence of SFIs among the study participants was 45%. In the rural, the prevalence was 29.6%, and in the urban prevalence was 60.4%. The types of SFIs were tinea capitis (the commonest), tinea corporis, pityriasis Versicolor, tinea unguium, and tinea manuum with prevalence rates lower in rural than urban communities. The clinical patterns were gray patch and black dot type of non-inflammatory tinea capitis, kerion, tinea corporis with trunk and limb distributions, and pityriasis Versicolor with face, trunk and limb distributions. Gray patch was the most frequent pattern of SFI seen in rural and urban communities. Black dot type was more frequent in rural than urban communities. SFIs were frequent among children aged 5 to 8years in rural and 9 to 12 years in urban communities. SFIs were commoner in males in the rural, whereas female dominance was observed in the urban. SFIs were more in children from low social class and those with poor hygiene. Trichophyton tonsurans and Trichophyton soudanese were the common mycological isolates in rural and urban communities, respectively. In conclusion, SFIs were less prevalent in rural than in urban communities. Trichophyton species were the most common fungal isolates in the communities. Health education of mothers and their children on SFI and good personal hygiene will reduce the incidence of SFIs.

Keywords: clinicomycological pattern, communities, primary school children, superficial fungal infections

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Authors: Ofira Zloto, Ofir Fogel, Eyal Klang

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Purpose: The aim is to develop an automated framework based on machine learning to diagnose malignant eyelid skin tumors. Methods: This study utilized eyelid lesion images from Sheba Medical Center, a large tertiary center in Israel. Before model training, we pre-trained our models on the ISIC 2019 dataset consisting of 25,332 images. The proprietary eyelid dataset was then used for fine-tuning. The dataset contained multiple images per patient, aiming to classify malignant lesions in comparison to benign counterparts. Results: The analyzed dataset consisted of images representing both benign and malignant eyelid lesions. For the benign category, a total of 373 images were sourced. In comparison, the malignant category has 186 images. Based on the accuracy values, the model with 3 epochs and a learning rate of 0.0001 exhibited the best performance, achieving an accuracy of 0.748 with a standard deviation of 0.034. At a sensitivity of 69%, the model has a corresponding specificity of 82%. To further understand the decision-making process of our model, we employed heatmap visualization techniques, specifically Gradient-weighted Class Activation Mapping. Discussion: This study introduces a dependable model-aided diagnostic technology for assessing eyelid skin lesions. The model demonstrated accuracy comparable to human evaluation, effectively determining whether a lesion raises a high suspicion of malignancy or is benign. Such a model has the potential to alleviate the burden on the healthcare system, particularly benefiting rural areas and enhancing the efficiency of clinicians and overall healthcare.

Keywords: machine learning;, eyelid skin tumors;, decision-making process;, heatmap visualization techniques

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Authors: Mohammad Mirwais Arghandiwal, Fujita Motohiro, Wisinee Wisetjindawat

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Since 2001, the new government of Afghanistan addressed the improvement of transportation in rural areas as one of the key issues for the country development. This paper thus, aims to show the impotency of transportation in the rural area of Kabul province. A field survey in Kabul Province capital of Afghanistan has been conducted during March, 2015, and 201 questionnaires were collected from four districts named Shakar Dara, Paghman, Char Asyab, and Khak Jabar to investigate the impacts of road transportation on the people’s daily life. The districts had their road projects constructed during the last 3-5 years. The interviewees are chosen randomly from a different category of districts residences. As transportation is one of the most important factors for the development of the communities, during the survey it was very easily to observe a positive effect on the life of people. The improvement on the accessibility has had a positive impact on the land and land price. In this paper, a model is created to show the relationship between different factors and the land price improvement. In the end, a recommendation is presented on the establishment of the community council for a better use and maintenance of road projects. We emphasize on a public and private partnership at a community level in the districts during the construction period too. In addition, the communities should be encouraged on their positive role in the improvement of transportation through their participation and collaboration with the local government.

Keywords: accessibility, Afghanistan, poverty, rural area, transportation development

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Authors: Sidiqat A. Aderinoye-Abdulwahab, Lateef L. Adefalu, Rashid S. Adisa, Felix O. Oladipo, Tawakalitu A. Dolapo

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This study investigates whether the rural women in Nigeria have access to productive resources such as land, livestock, and capital in order to determine their level of socio-economic empowerment. The study adopted a case study design while employing qualitative and quantitative methods of data collection. A multi-stage sampling technique was used to identify 7 locations, where 88 women were selected based on simple random sampling technique. Focus group discussions and questionnaire were used to elicit information. Gender analysis framework was used to explore and analyse the data generated for the study. The study found that the rural women desire to engage in gainful economic activities. However, cultural barriers prevent them from adequately exploring livelihood-improving opportunities. It was established that ownership of productive resources such as land and livestock can enhance their livelihoods provided cultural and governance issues do not deter them from accessing the services. It was therefore recommended that appropriate policies that will favour the access and ownership of assets by women so as to empower them need to be in place. The study provides a nuanced perspective on the influence and relevance of possession of physical assets in enhancing women’s livelihood diversification and overall development of rural livelihoods.

Keywords: livelihoods, productivity, development, economic activities, socio-economic empowerment

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Authors: Changaiz Khan

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Pakistan has the highest rates of maternal mortality in South Asia. From the year 2000 to 2017 the global rate of maternal mortality has decreased up to 39 %. In the context of South Asia, it has decreased by 59% since 2000s. Pakistan has also reduced the rate of maternal mortality, but there is a difference on the provincial level. According to the report of the National Institute of Population Studies (NIPS) conducted in 2020, the MMR in Balochistan has crossed the ratio of most of the South Asian countries, i.e., 298 maternal deaths per 100,000 live births. In comparison, the province of Punjab has the lowest maternal mortality rate i.e. 157 deaths (per 100,000 live births). The rate of maternal mortality is much higher in Balochistan as compared to the other provinces. This research is aimed to discuss the supply side barriers and utilization of maternal healthcare services in the District Gwadar. Likert scale survey method has been used to collect data from the Healthcare Professionals from hospitals -private and government- and the maternal healthcare receiver, that is patient. Semi-structured interviews of healthcare professionals such as doctors, nurses, and Lab technicians have also been conducted. It has been found in this research study that the hospitals in Gwadar district are lagging behind in providing modern maternal healthcare to women due to the lack of staff training, medicine supply, and Laboratories. Moreover, the system of the lady health worker is also not catering to the needs of the women in District Gwadar. It has been recommended in the study that first of all the government should fulfill the supply of the medicine in the hospital. Secondly, the government should open laboratories in the hospitals. Thirdly, the government should increase the funding of the government hospital and the allocation of lady health workers in District Gwadar, Balochistan should be increased.

Keywords: maternal mortality, neonatal, postnatal, supply barriers, patients, healthcare professionals, laboratory, medical supply, training

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Authors: Jeremy Schultz

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The purpose of this study was to understand the perceptions of vineyard managers in the Krasnodar Region of Southern Russia located between the city of Kransnodar and the Black Sea. In recent years, wine tourism throughout the region has seen tremendous growth due in part to the concurrent growth in the number of tourists vacationing at the Black Sea. This trend has contributed to the development of large-scale wine operations developing in numerous rural locations along the tourists’ travel path. Niche areas of tourism, such as wine tourism, have proven to provide economic viability for rural communities all around the world. Understanding their shared group characteristics while honoring their unique qualities as individuals aids in responsible wine tourism development that provides a sense of well-being for the communities and stakeholders involved. Semi-structured interviews and lived experience methodologies were used in locations that were associated with wine food tourism operations. By understanding management perspectives, it lends insight into sustainable destination management and wine tourism product development, furthering our progress toward ethical, responsible, and financially feasible operations. This research also represents a collaborative effort between Russia and the United States that supports an agenda of sustainable destination development and management. As a global community, we need to continue to investigate stakeholder perceptions and strategic management techniques that best support the pillars upon which responsible tourism was founded.

Keywords: wine tourism, tourism development, Russia, rural tourism

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Authors: M. Zayoud, S. Oueida, S. Ionescu, P. AbiChar

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Background: Wireless sensor network is encompassed of diversified tools of information technology, which is widely applied in a range of domains, including military surveillance, weather forecasting, and earthquake forecasting. Strengthened grounds are always developed for wireless sensor networks, which usually emerges security issues during professional application. Thus, essential technological tools are necessary to be assessed for secure aggregation of data. Moreover, such practices have to be incorporated in the healthcare practices that shall be serving in the best of the mutual interest Objective: Aggregation of encrypted data has been assessed through homomorphic stream cipher to assure its effectiveness along with providing the optimum solutions to the field of healthcare. Methods: An experimental design has been incorporated, which utilized newly developed cipher along with CPU-constrained devices. Modular additions have also been employed to evaluate the nature of aggregated data. The processes of homomorphic stream cipher have been highlighted through different sensors and modular additions. Results: Homomorphic stream cipher has been recognized as simple and secure process, which has allowed efficient aggregation of encrypted data. In addition, the application has led its way to the improvisation of the healthcare practices. Statistical values can be easily computed through the aggregation on the basis of selected cipher. Sensed data in accordance with variance, mean, and standard deviation has also been computed through the selected tool. Conclusion: It can be concluded that homomorphic stream cipher can be an ideal tool for appropriate aggregation of data. Alongside, it shall also provide the best solutions to the healthcare sector.

Keywords: aggregation, cipher, homomorphic stream, encryption

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Authors: Sarieh Poortaghi, Zakiyeh Jafaryparvar, Marzieh Hasanpour, Reza Negarandeh

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Aim: This article aims to discuss how violence against health care workers especially nurses affects health care systems and the quality of care of the patients. In this paper causes of violence and strategies to reduce it have been discussed. Methods: Discourse of the literature considering the violence against nurses during the COVID-19 pandemic and its reasons and outcomes. Results: The COVID-19 pandemic has led to a significant increase in violence against healthcare providers. The attacker against nurses may be among patients, companions, visitors, colleagues such as doctors and other nurses, supervisors, and managers. Many individuals who experience violence in healthcare environments refrain from reporting it. The causes of violence against nurses include spending long periods with patients, perceiving nursing as a low-status profession, gender of nurses, direct and frequent contact with patients and their companions, inadequate facilities and high workload, weak healthcare delivery systems in public hospitals and inequality in health, nature of the department and shift type of personnel, work shifts and staff shortages, forcing nurses to work in non-standard conditions during the COVID-19 pandemic, prohibition of patient visits during the pandemic, patient death and nurses' sense of incompetence, and expressing stress through aggression. Workplace violence leads to a decrease in job satisfaction and an increase in continuous psychological stress, which has a negative impact on the personal and professional lives of nurses. Potential strategies for reducing workplace violence include protecting healthcare workers through laws, improving communication with patients and their families, critically analyzing information in social media, facilitating patient access through remote medical strategies, and improving access to primary healthcare services.

Keywords: nurses, health care workers, Covid-19, nursing

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Authors: R. Cooper, M. Kurien

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Background: Coeliac Disease affects around 1 in 100 people. Untreated, it can result in serious morbidity such as malabsorption and cancers. The only treatment is to adhere to a gluten free diet (GFD). International guidelines recommend that people with the coeliac disease receive follow-up healthcare annually to detect complications early and support their adherence to a GFD. However, there is a finite amount of healthcare in the UK, and as such, not all patients receive follow-up care as recommended by the guidelines. Furthermore, there is an increasing number of patients being diagnosed with coeliac disease. Given the potential severe morbidity that non-adherence to a GFD could result in, alongside reports that the rate of non- GFD adherence could be as high as 91%, it is imperative that action is taken. One potential solution to this would be to provide follow-up care digitally through utilising technology. This abstract reports on a rapid review undertaken to explore the existing evidence in this area. Methods: In June 2020, 11 bibliographic databases were searched to find any pertinent studies. The inclusion criteria required the study to be written in the English language and report on the use of digital healthcare interventions for people with Coeliac Disease. Results: A small amount of evidence (n=8) was found which met our inclusion criteria and pertained to the provision of CD follow-up digitally. These studies focussed either on educating and supporting patients to adhere to a GFD or providing consultation remotely with a focus on detecting complications early. These studies showed that there is potential for digital healthcare interventions to positively impact people with coeliac disease. However, it is suggested that the effectiveness of these interventions may depend on local circumstances, individual knowledge of CD and general attitudes. Conclusion: The above studies suggest that providing follow-up care digitally may offer a potential solution; however, the evidence about how this should be done and in what circumstances this will work for individuals is scarce. In the light of the COVID-19 pandemic, the introduction of digital healthcare interventions appears to be highly topical, and as such, this review may benefit from being refreshed in the future.

Keywords: coeliac disease, follow-up, gluten free diet, digital healthcare interventions

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Authors: Jill Garner, Belinda Lange, Sheila Lennon, Maayken van den Berg

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Currently, there are approximately one billion people worldwide affected by a neurological condition. Many of whom are assessed and treated by a physiotherapist in a variety of settings. There is a lack of consensus in the literature related to what is clinically assessed by physiotherapists in people with neurological conditions. This study aimed to explore assessment in people with neurological conditions, including how health care setting, experience, and therapeutic approach, may influence neurological assessment. A national survey targeted Australian physiotherapists who assess adults with neurological conditions as part of their clinical practice. The survey consisted of 39 questions and was distributed to physiotherapists through the Australian Physiotherapy Association, and Chief Allied Health Officers across Australia and advertised on the National Neurological Physiotherapy Facebook page. In total, 395 respondents consented to the survey from all states within Australia. Most respondents were female (85.4%) with a mean (SD) age of 35.7 years. Respondents reported working clinically in acute, community, outpatients, and community settings. Stroke was the most assessed condition (58.0%). There is variability in domains assessed by Australian physiotherapists, with common inclusions of balance, muscle strength, gait, falls and safety, function, goal setting, range of movement, pain, coordination, activity tolerance, postural alignment and symmetry and upper limb. There is little evidence to support what physiotherapists assess in practice, in different settings, and in different states within Australia and not enough information to develop a decision tree regarding what is important for assessment in different settings. Further research is needed to explore this area and develop a consensus around best practices.

Keywords: physiotherapy, neurological, assessment, domains

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Authors: Emma Pope, Demos Parapanos

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Rural tourism has become more obvious and prevalent, with tourists’ increasingly seeking authentic experiences. This movement accelerated post-Covid, putting destinations in danger of reaching levels of saturation called ‘overtourism’. Whereas the phenomenon of overtourism has been frequently discussed in the urban context by academics and practitioners over recent years, it has hardly been referred to in the context of rural tourism, where perhaps it is even more difficult to manage. Rural tourism was historically considered small-scale, marked by its traditional character and by having little impact on nature and rural society. The increasing number of rural areas experiencing overtourism, however, demonstrates the need for new approaches, especially as the impacts and enablers of overtourism are context specific. Cumbria, with approximately 47 million visitors each year, and 23,000 operational enterprises, is one of these rural areas experiencing overtourism in the UK. Using the county of Cumbria as an example, this paper aims to explore better planning and management in rural destinations by clustering the area into rural and ‘urban-rural’ tourism zones. To achieve the aim, this study uses secondary data from a variety of sources to identify variables relating to visitor economy development and demand. These data include census data relating to population and employment, tourism industry-specific data including tourism revenue, visitor activities, and accommodation stock, and big data sources such as Trip Advisor and All Trails. The combination of these data sources provides a breadth of tourism-related variables. The subsequent analysis of this data draws upon various validated models. For example, tourism and hospitality employment density, territorial tourism pressure, and accommodation density. In addition to these statistical calculations, other data are utilized to further understand the context of these zones, for example, tourist services, attractions, and activities. The data was imported into ARCGIS where the density of the different variables is visualized on maps. This study aims to provide an understanding of the geographical context of visitor economy development and tourist behavior in rural areas. The findings contribute to an understanding of the spatial dynamics of tourism within the region of Cumbria through the creation of thematized maps. Different zones of tourism industry clusters are identified, which include elements relating to attractions, enterprises, infrastructure, tourism employment and economic impact. These maps visualize hot and cold spots relating to a variety of tourism contexts. It is believed that the strategy used to provide a visual overview of tourism development and demand in Cumbria could provide a strategic tool for rural areas to better plan marketing opportunities and avoid overtourism. These findings can inform future sustainability policy and destination management strategies within the areas through an understanding of the processes behind the emergence of both hot and cold spots. It may mean that attract and disperse needs to be reviewed in terms of a strategic option. In other words, to use sector or zonal policies for the individual hot or cold areas with transitional zones dependent upon local economic, social and environmental factors.

Keywords: overtourism, rural tourism, sustainable tourism, tourism planning, tourism zones

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Authors: Chia-Chen Wei, Pack Hsieh, Jeffrey Chen

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Surface Mount Technology (SMT) is widely used in the area of the electronic assembly in which the electronic components are mounted to the surface of the printed circuit board (PCB). Most of the defects in the SMT process are mainly related to the quality of solder paste printing. These defects lead to considerable manufacturing costs in the electronics assembly industry. Therefore, the solder paste inspection (SPI) machine for controlling and monitoring the amount of solder paste printing has become an important part of the production process. So far, the setting of the SPI threshold is based on statistical analysis and experts’ experiences to determine the appropriate threshold settings. Because the production data are not normal distribution and there are various variations in the production processes, defects related to solder paste printing still occur. In order to solve this problem, this paper proposes an online machine learning algorithm, called the automatic threshold adjustment (ATA) algorithm, and closed-loop architecture in the SMT process to determine the best threshold settings. Simulation experiments prove that our proposed threshold settings improve the accuracy from 99.85% to 100%.

Keywords: big data analytics, Industry 4.0, SPI threshold setting, surface mount technology

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Authors: K. Power, M. White, B. Dunleavey, E. Comerford, C. Doherty, N. Delanty, R. Corbridge, M. Fitzsimons

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Introduction: Providing people with access to their own healthcare information and engaging them as co-authors of their health record can promote better transparency, trust, and inclusivity in the healthcare system. With the advent of electronic health records, there is a move towards involving patients as partners in their healthcare by providing them with access to their own health data via electronic patient portals (ePortal). For example, a recently developed ePortal to the Irish National Epilepsy Electronic Patient Record (EPR) provides access to summary medical records, tools for Patient Reported Outcomes (PROM), health goal-setting and preparation for clinical appointments. Aim: To determine what people with epilepsy (their families/carers) value about the Irish epilepsy ePortal. Methods: A socio-technical process was employed recruiting 30 families of people with epilepsy who also have an intellectual disability (ID). Family members who are a care partner of the person with epilepsy (PWE) were invited to co-design, develop and implement the ePortal. Family members engaged in usability and utility testing which involved a face to face meeting to learn about the ePortal, register for a user account and evaluate its structure and content. Family members were instructed to login to the portal on at least two separate occasions following the meeting and to complete a self-report evaluation tool during this time. The evaluation tool, based on a Usability Questionnaire (Lewis, 1993), consists of a short assessment of comfort using technology, instructions for using the ePortal and some tasks to complete. Tasks included validating summary record details, assessing ePortal ease of use, evaluation of information presented. Participants were asked for suggestions on how to improve the portal and make it more applicable to PWE who also have an ID. Results: Family members responded positively to the ePortal and valued the ability to share information between clinicians and care partners; use the ePortal as a passport between different healthcare settings (e.g., primary care to hospital). In the context of elderly parents of PWE, the ePortal is valued as a tool for supporting shared care between family members. Participants welcomed the facility to log lists of questions and goals to discuss with the clinician at the next clinical appointment as a means of improving quality of care. Participants also suggested further enhancements to the ePortal such as access to clinic letters which can provide an aide memoir in terms of the careplan agreed with the clinical team. For example, through the ePortal, people could see what investigations or therapies are scheduled. Conclusion: The Epilepsy Patient Portal is accessible via a range of devices such as smartphones and tablets. ePortals have the potential to help personalise care, improve patient involvement in clinical decision making, engage them as quality and safety partners, and help clinicians be more responsive to patient needs. Acknowledgement: The epilepsy ePortal project is part of PISCES, a Lighthouse Project funded by eHealth Ireland and HSE to help build an understanding of the benefits of eHealth technologies in the Irish Healthcare System.

Keywords: electronic patient portal, electronic patient record, epilepsy, intellectual disability, usability testing

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Authors: L. V. S. S. Phaneendra Bolem, S. Shankar

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Low Volume Rural Roads (LVRRs) constitute an integral component of the road system in all countries. These encompass all aspects of the social and economic development of rural communities. It is known that on a worldwide basis the number of low traffic roads far exceeds the length of high volume roads. Across India, 90% of the roads are LVRRs, and they often form the most important link in terms of providing access to educational, medical, recreational and commercial activities in local and regional areas. In the recent past, Government of India (GoI), with the initiation of the ambitious programme namely 'Pradhan Mantri Gram Sadak Yojana' (PMGSY) gave greater importance to LVRRs realizing their role in economic development of rural communities. The vast expansion of the road network has brought connectivity to the rural areas of the country. Further, it is noticed that due to increasing axle loads and lack of timely maintenance, is accelerated the process of deterioration of LVRRs. In addition to this due to limited budget for maintenance of these roads systematic and scientific approach in utilizing the available resources has been necessitated. This would enable better prioritization and ranking for the maintenance and make ‘all-weather roads’. Taking this into account the present study has adopted a multi-criteria approach. The multi-criteria approach includes parameters such as social, economic, environmental and pavement condition as the main criterion and some sub-criteria to find the best suitable parameters and their weight. For this purpose the expert’s opinion survey was carried out using Delphi Technique (DT) considering Likert scale, pairwise comparison and ranking methods and entire data was analyzed. Finally, this study developed the maintenance criterion considering the socio-economic, environmental and pavement condition parameters for effective maintenance of low volume roads based on the engineering judgment.

Keywords: Delphi technique, experts opinion survey, low volume rural road maintenance, multi criteria analysis

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Authors: Minna Pikkarainen, Yueqiang Xu

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The integration of digital technology with existing healthcare processes has been painfully slow, a huge gap exists between the fields of strictly regulated official medical care and the quickly moving field of health and wellness technology. We claim that the promises of preventive healthcare can only be fulfilled when this gap is closed – health care and self-care becomes seamless continuum “correct information, in the correct hands, at the correct time allowing individuals and professionals to make better decisions” what we call connected health approach. Currently, the issues related to security, privacy, consumer consent and data sharing are hindering the implementation of this new paradigm of healthcare. This could be solved by following MyData principles stating that: Individuals should have the right and practical means to manage their data and privacy. MyData infrastructure enables decentralized management of personal data, improves interoperability, makes it easier for companies to comply with tightening data protection regulations, and allows individuals to change service providers without proprietary data lock-ins. This paper tackles today’s unprecedented challenges of enabling and stimulating multiple healthcare data providers and stakeholders to have more active participation in the digital health ecosystem. First, the paper systematically proposes the MyData approach for healthcare and preventive health data ecosystem. In this research, the work is targeted for health and wellness ecosystems. Each ecosystem consists of key actors, such as 1) individual (citizen or professional controlling/using the services) i.e. data subject, 2) services providing personal data (e.g. startups providing data collection apps or data collection devices), 3) health and wellness services utilizing aforementioned data and 4) services authorizing the access to this data under individual’s provided explicit consent. Second, the research extends the existing four archetypes of orchestrator-driven healthcare data business models for the healthcare industry and proposes the fifth type of healthcare data model, the MyData Blockchain Platform. This new architecture is developed by the Action Design Research approach, which is a prominent research methodology in the information system domain. The key novelty of the paper is to expand the health data value chain architecture and design from centralization and pseudo-decentralization to full decentralization, enabled by blockchain, thus the MyData blockchain platform. The study not only broadens the healthcare informatics literature but also contributes to the theoretical development of digital healthcare and blockchain research domains with a systemic approach.

Keywords: blockchain, health data, platform, action design

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Authors: J. O. Ayinde, S. O. Olatunji

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This study assessed rural youth adoption of cassava production technologies in Southwestern, Nigeria. Specifically, it examine the level of awareness and adoption of cassava production technologies by rural youth, determined the extent of usage of cassava production technologies available to the rural youth, examined constrains to the adoption of cassava production technologies by youth and suggested possible solutions. Multistage sampling procedure was adopted for the study. In the first stage, two states were purposively selected in southwest, Nigeria which are Osun and Oyo states due to high level of cassava production and access to cassava production technology in the areas. In the second stage, purposive sampling technique was used to select two local governments each from the states selected which are Ibarapa central (Igbo-Ora) and Ibarapa East (Eruwa) Local Government Areas (LGAs) in Oyo state; and Ife North (Ipetumodu) and Ede South (Oke Ireesi) LGAs in Osun State. In the third stage, proportionate sampling technique was used to randomly select five, four, six and four communities from the selected LGAs respectively representing 20 percent of the rural communities in them, in all 19 communities were selected. In the fourth stage, Snow ball sampling technique was used to select about 7 rural youths in each community selected to make a total of 133 respondents. Validated structured interview schedule was used to elicit information from the respondents. The data collected were analyzed using both descriptive and inferential statistics to summarize and test the hypotheses of the study. The results show that the average age of rural youths participating in cassava production in the study area is 29 ± 2.6 years and 60 percent aged between 30 and 35 years. Also, more male (67.4 %) were involved in cassava production than females (32.6 %). The result also reveals that the average size of farm land of the respondents is 2.5 ± 0.3 hectares. Also, more male (67.4 %) were involved in cassava production than females (32.6 %). Also, extent of usage of the technologies (r = 0.363, p ≤ 0.01) shows significant relationship with level of adoption of the technologies. Household size (b = 0.183; P ≤ 0.01) and membership of social organizations were significant at 0.01 (b = 0.331; P ≤ 0.01) while age was significant at 0.10 (b = 0.097; P ≤ 0.05). On the other hand 0.01, years of residence (b = - 0.063; P ≤ 0.01) and income (b = - 0.204; P ≤ 0.01) had negative values and implies that a unit increase in each of these variables would decrease extent of usage of the Cassava production technologies. It was concluded that the extent of usage of the technologies in the communities will affect the rate of adoption positively and this will change the negative perception of youths on cassava production thereby ensure food security in the study area.

Keywords: assessment, rural youths’, Cassava production technologies, agricultural production, food security

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Authors: Martha Karunakar

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There exists a wide divide between the urban and the rural students in a vast country like India. This dichotomy is seen in the resources available to them, like the learning facilities, the infra-structure, the learning ambience and meeting of their basic needs of food, clothing and shelter. This paper discusses the effect of English language teaching as a Bridge course on a select batch of rural students at an Engineering college in Chennai, one of the four Metros of India. The study aims to understand how the teacher input and the teacher- peer-student interaction facilitates the acquisition of the basic structures of the English language to a group that is minimally exposed to the language. The objective in conducting the Bridge Course is to integrate these rural students into the mainstream and empower them in terms of English speaking ability; to enable them to comprehend their respective engineering classes where the medium of instruction is English and also to be able to interact with their urban peers. This program is conducted prior to the start of a regular academic session to equip them face the rigors of engineering education. The study is placed within the framework of Interaction theory in second language acquisition. The study evaluates the impact of linking theory and practice by implementing meaningful interaction not only within classrooms but also in the common areas. By providing intensive comprehensible input, it is anticipated that participant’s level of English language improves. The teaching methods and classroom activities included individual and group participation, encompassing all the four skills of listening, speaking, reading and writing (LSRW). The diagnostic tests that were administered before the commencement of the course and the exit test after the completion were used to record the impact of the training.

Keywords: comprehensible input, interaction, rural students, teaching English

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Authors: Clemens Pizzinini, Philipp Rosner, David Ziegler, Markus Lienkamp

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Transportation is a constitutional part of most supply and value chains in modern economies. Smallholder farmers in rural Ethiopia face severe challenges along their supply and value chains. In particular, suitable, affordable, and available transport services are in high demand. To develop a context-specific technical solutions, a problem-to-solution methodology based on the interaction with technology is developed. With this approach, we fill the gap between proven transportation assessment frameworks and general user-centered techniques. Central to our approach is an electric test vehicle that is implemented in rural supply and value chains for research, development, and testing. Based on our objective and the derived methodological requirements, a set of existing methods is selected. Local partners are integrated into an organizational framework that executes major parts of this research endeavour in the Arsi Zone, Oromia Region, Ethiopia.

Keywords: agricultural value chain, participatory methods, agile methods, sub-Saharan Africa, Ethiopia, electric vehicle, transport service

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Authors: Martin Mundo-Molina

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In Mexico, there are many small rural communities with serious water supply deficiencies. In Chiapas, Mexico, there are 19,972 poor rural communities, 15,712 of which have fewer than 100 inhabitants. The lack of a constant water supply is most severe in the highlands of Chiapas where the population is made up mainly of indigenous groups. The communities are on mountainous terrain with a widely dispersed population. These characteristics combine to make the provision of public utilities, such as water, electricity and sewerage, difficult with conventional means. The introduction of alternative, low-cost technologies represents means of supplying water such as through fog and rain catchment with zero greenhouse emissions. In this paper is presented the rainwater harvesting system (RWS) constructed in Yalentay, Chiapas Mexico. The RWS is able to store 1.2 M liters of water to provide drinking water to small rural indigenous communities of 500 people in the drought stage. Inside the system of rainwater harvesting there isn't photosynthesis in order to conserve water for long periods. The natural filters of the system of rainwater harvesting guarantee the drinking water for using to the community. The combination of potability and low cost makes rain collection a viable alternative for rural areas, weather permitting. The Mexican Institute of Water Technology and Chiapas University constructed a rainwater harvesting system in Yalentay Chiapas, it consists of four parts: 1. Roof of aluminum, for collecting rainwater, 2. Underground-cistern, divided in two tanks, 3. Filters, to improve the water quality and 4. The system of rainwater harvesting dignified the lives of people in Yalentay, saves energy, prevents the emission of greenhouse gases into the atmosphere, conserves natural resources such as water and air.

Keywords: appropriate technologies, climate change, greenhouse gases, rainwater harvesting

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Authors: Mahnaz Khalafehnilsaz, Rozina Rahnama

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Introduction: The elderly population is growing rapidly, and with this growth comes an increased demand for healthcare services. Artificial intelligence (AI) has the potential to revolutionize the delivery of healthcare services to the elderly population. In this study, the various ways in which AI is used to create health content for elderly people and its transformative impact on the healthcare industry will be explored. Method: A systematic review of the literature was conducted to identify studies that have investigated the role of AI in creating health content specifically for elderly people. Several databases, including PubMed, Scopus, and Web of Science, were searched for relevant articles published between 2000 and 2022. The search strategy employed a combination of keywords related to AI, personalized health content, and the elderly. Studies that utilized AI to create health content for elderly individuals were included, while those that did not meet the inclusion criteria were excluded. A total of 20 articles that met the inclusion criteria were identified. Finding: The findings of this review highlight the diverse applications of AI in creating health content for elderly people. One significant application is the use of natural language processing (NLP), which involves the creation of chatbots and virtual assistants capable of providing personalized health information and advice to elderly patients. AI is also utilized in the field of medical imaging, where algorithms analyze medical images such as X-rays, CT scans, and MRIs to detect diseases and abnormalities. Additionally, AI enables the development of personalized health content for elderly patients by analyzing large amounts of patient data to identify patterns and trends that can inform healthcare providers in developing tailored treatment plans. Conclusion: AI is transforming the healthcare industry by providing a wide range of applications that can improve patient outcomes and reduce healthcare costs. From creating chatbots and virtual assistants to analyzing medical images and developing personalized treatment plans, AI is revolutionizing the way healthcare is delivered to elderly patients. Continued investment in this field is essential to ensure that elderly patients receive the best possible care.

Keywords: artificial intelligence, health content, older adult, healthcare

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Authors: Jeana Cadby, Kae Miyazawa

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With rapidly expanding worldwide adoption of mobile technologies, Information and Communication Technology (ITC) is a major energy user and a contributor to global carbon emissions, due to infrastructure and operational energy consumption. The agricultural sector is also significantly responsible for contributing to global carbon emissions. However, ICT cloud computing using mobile technology can directly reduce environmental impacts in the agricultural sector through applications and mobile connectivity, such as precision fertilizer and pesticide applications, or access to weather data, for example. While direct impacts are easily calculated, indirect environmental impacts from ICT cloud computing usage have not been thoroughly investigated. For example, while women may be more poorly equipped for adaptation to environmentally sustainable agricultural practices due to resource constraints, this research concludes that indirect environmental benefits can be achieved by improving rural access to mobile technology for women. Women in advanced roles and secure land tenure are more likely to invest in long-term agricultural conservation strategies, which protect against environmental degradation. This study examines how ICT using mobile technology advances the role of women in rural agricultural systems and indirectly reduces environmental impacts from agricultural production, through literature examination from secondary sources. Increasing access for women to ICT mobile technology provides indirect environmental and social benefits in the rural agricultural sector.

Keywords: cloud computing, environmental benefits, mobile technology, women

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Authors: Meirav Eshkol, Miri Blaufeld, Rinat Basal

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Aim: The working environment in rural clinics is often isolated and distant from major health centers. In these circumstances, rural health care faces numerous challenges. The hope is that, in the immediate future and in the medium and long range, the rural nursing staff will realize their full professional and personal potential to their own satisfaction and to the health and welfare of their patients. Background: Rural nurses work mostly alone or with very few colleagues, and have the authority to make professional decisions, a fact which often requires them to make critical decisions in pressure situations. In addition, the expectations set for these nurses are extremely high, a fact which requires them to be extremely skilled and to fulfill their professional potential. They are required to provide high-quality and comprehensive care to the individual, the family, and the community and to maintain close interaction with the community. Work in a rural setting requires the flexibility to perform multiple tasks in an isolated setting, often far removed from major health centers. In order to maintain professional satisfaction for the rural nurse, expanded direction and training are required in professional know-how, and in the development of new and existing skills, toward the goal of treating a diverse population and to obtain a comprehensive view of the components of a diagnosis for treatment and to develop an understanding appropriate to the presented reality. Objective: To provide knowledge and to expand and develop professional skills in the prevention and advancement of health in the care of a diverse patient population. The development of strategies and skills for work under pressure alone instills expertise in performing multiple tasks in diverse disciplines. To reduce feelings of stress and burnout. Methodology: This course is the first and one of a kind in Clalit - the biggest health organisation in Israel. Observing and identifying the needs of the nurses in the field relating to the development of professional and personal skills defining goals and objectives, and determining the content of a course designed for rural nurses and kibbutz nurses who are not Clalit employees. Results: 43 nurses participated and 30 answered the feedback questionnaire. The rating of their experience was 4.33 (on a scale of 1-5, with 5 being the highest ranking). 92% indicated the importance of meeting with additional nurses to teach their colleagues. 83% of the nurses indicated an increased sense of organizational belonging. 60% indicated that the course helped to reduce feelings of stress and burnout in becoming a better rural nurse. 80% indicated that the course helped them establish intra-organizational professional cooperation and initiating processes. Conclusion: The course is an instrument which aids in increasing the feeling of organizational belonging, reducing feelings of stress and burnout, creation of relationships and cooperation both within and outside of the organization, increased the realization of the potential of the village nurse.

Keywords: rural nurse, alone, burnout, multiple tasks

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Authors: Tia Claridge

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The aim of this study was to explore whether there are gender differences in how early childhood educators view and facilitate rough and tumble play in England. A qualitative approach was used to carry out semi-structured interviews with female and male early years educators. The key rationale for this study was to examine the significant lack of males working in early years education and the consequent impact this has on pedagogical practice. The findings illustrated that there are some gender differences in educators’ perspectives of rough and tumble play. These include how educators use their own childhood experience to inform their professional practice as well as identifying a need for tailored training to upskill and develop confidence in early years staff with regard to this type of play. The most surprising finding was the influence that urban and rural settings had on educators’ perceptions on weapon play, regardless of gender. Awareness of educator positionality was significant throughout the study for male participants, whereas females rarely commented their own gender. These findings indicate that further research is needed to understand the complex narratives underpinning gender and rough and tumble play.

Keywords: rough and tumble play, educators, gender, early years, pedagogy

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Authors: Kenneth Nhundu, Leocadia Zhou, Farhad Aghdasi, Voster Muchenje

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Climate change poses increased risks to rural communities that rely on natural resources, such as forests, cropland and rangeland, waterways, and open spaces Because of their connection to the land and the potential for climate change to impact natural resources and disrupt ecosystems and seasons, rural livelihoods and well-being are disproportionately vulnerable to climate change. Climate change has the potential to affect the environment in a number of ways that place increased stress on everyone, but disproportionately on the most vulnerable populations, including the young, the old, those with chronic illness, and the poor. The communities in the study area are predominantly rural, resource-based and are generally surrounded by public or private lands that are dominated by natural resources, including forests, rangelands, and agriculture. The livelihoods of these communities are tied to natural resources. Therefore, targeted strategies to cope will be required. This paper assessed the household socio-economic characteristics and their implications to household vulnerability to climate change impacts in the rural Eastern Cape Province, South Africa. The results indicate that the rural communities are climate-vulnerable populations as they have a large proportion of people who are less economically or physically capable of adapting to climate change. The study therefore recommends that at each level, the needs, knowledge, and voices of vulnerable populations, including indigenous peoples and resource-based communities, deserve consideration and incorporation so that climate change policy (1) ensures that all people are supported and able to act, (2) provides as robust a strategy as possible to address a rapidly changing environment, and (3) enhances equity and justice.

Keywords: climate change, vulnerable, socio-economic, livelihoods

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Authors: Etaf Alkhlaifat

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This study drew conceptually on Communication Accommodation Theory to describe and analyze conversations between doctors and patients to examine the extent to which patients’ level of literacy represents one of the linguistic obstacles that may adversely influence the quality of healthcare services in Jordan. A thematic qualitative approach was employed to interpret the phenomena under study, which required direct observation and interviews with doctors (n=6) and patients (n=15) in natural Jordanian medical settings. This generated a comprehensive corpus of audio and videotaped data, which revealed that most doctors expressed dissatisfaction with patients’ ability to express themselves and comprehend them as a result of a lack of medical awareness and limited health education. The significance of this study rests on its detailed investigation of the impact of health literacy on patients’ health outcomes and while providing unique insights into how low health literacy could contribute to misunderstanding and potential ill-health.

Keywords: doctor-patient communication, health literacy, medical knowledge, communication accommodation theory, qualitative research

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Authors: Moshmi Sangavarapu

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The US healthcare industry has undergone tremendous digital transformation in recent years, but critical care access to lower-income ethnicities is still in its nascency. This population has historically showcased substantial hesitation to seek any medical assistance. While the lack of sufficient financial resources plays a critical role, the existing cultural and knowledge barriers also contribute significantly to widening the access gap. It is imperative to break these barriers to ensure timely access to therapeutic procedures that can save important lives! Based on ongoing research, healthcare access barriers can be best addressed by tapping the untapped potential of caregiver communities first. They play a critical role in patients’ diagnoses, building healthcare knowledge and instilling confidence in required therapeutic procedures. Recent technological advancements have opened many avenues by developing smart ways of reaching the large caregiver community. A digitized go-to-market strategy featuring connected media coupled with smart IoT devices and geo-location targeting can be collectively leveraged to reach this key audience group. AI/ML algorithms can be thoroughly trained to identify relevant data signals from users' location and browsing behavior and determine useful marketing touchpoints. The web behavior can be further assimilated with natural language processing to identify contextually relevant interest topics and decipher potential caregivers on digital avenues to serve that brand message. In conclusion, grasping the true health access journey of any lower-income ethnic group is important to design beneficial touchpoints that can alleviate patients’ concerns and allow them to break their own access barriers and opt for timely and quality healthcare.

Keywords: healthcare access, market access, diversity barriers, patient journey

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Authors: Emily Saurman, David Lyle

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In Australia, a well serviced rural town might have a psychiatrist visit once-a-month with more frequent visits from a psychiatric nurse, but many have no resident access to mental health specialists. Access to specialist care, would not only reduce patient distress and benefit outcomes, but facilitate the effective use of limited resources. The Mental Health Emergency Care-Rural Access Program (MHEC-RAP) was developed to improve access to specialist emergency mental health care in rural and remote communities using telehealth technologies. However, there has been no current benchmark to gauge program efficiency or capacity; to determine whether the program activity is justifiably sufficient. The evaluation of MHEC-RAP used multiple methods and applied a modified theory of access to assess the program and its aim of improved access to emergency mental health care. This was the first evaluation of a telepsychiatry service to include a time and motion study design examining program time expenditure, efficiency, and capacity. The time and motion study analysis was combined with an observational study of the program structure and function to assess the balance between program responsiveness and efficiency. Previous program studies have demonstrated that MHEC-RAP has improved access and is used and effective. The findings from the time and motion study suggest that MHEC-RAP has the capacity to manage increased activity within the current model structure without loss to responsiveness or efficiency in the provision of care. Enhancing program responsiveness and efficiency will also support a claim of the program’s value for money. MHEC-RAP is a practical telehealth solution for improving access to specialist emergency mental health care. The findings from this evaluation have already attracted the attention of other regions in Australia interested in implementing emergency telepsychiatry programs and are now informing the progressive establishment of mental health resource centres in rural New South Wales. Like MHEC-RAP, these centres will provide rapid, safe, and contextually relevant assessments and advice to support local health professionals to manage mental health emergencies in the smaller rural emergency departments. Sharing the application of this methodology and research activity may help to improve access to and future evaluations of telehealth and telepsychiatry services for others around the globe.

Keywords: access, emergency, mental health, rural, time and motion

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Authors: Giuliana Murfet, Heidi Behrens

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Chronic disease is Australia’s biggest health concern and obesity the leading risk factor for many. Obesity and chronic disease have a higher representation in rural Tasmania, where levels of socio-disadvantage are also higher. People living outside major cities have less access to health services and poorer health outcomes. To help primary healthcare professionals manage obesity, the Australian NHMRC evidence-based clinical practice guidelines for management of overweight and obesity in adults were developed. They include recommendations for practice and models for obesity management. To our knowledge there has been no research conducted that investigates translation of these guidelines into practice in rural-regional areas; where implementation can be complicated by limited financial and staffing resources. Also, the systematic review that informed the guidelines revealed a lack of evidence for chronic disease models of obesity care. The aim was to establish and evaluate a multidisciplinary model for obesity management in a group of adult people with type 2 diabetes in a dispersed rural population in Australia. Extensive stakeholder engagement was undertaken to both garner support for an obesity clinic and develop a sustainable model of care. A comprehensive nurse practitioner-led outpatient model for obesity care was designed. Multidisciplinary obesity clinics for adults with type 2 diabetes including a dietitian, psychologist, physiotherapist and nurse practitioner were set up in the north-west of Tasmania at two geographically-rural towns. Implementation was underpinned by the NHMRC guidelines and recommendations focused on: assessment approaches; promotion of health benefits of weight loss; identification of relevant programs for individualising care; medication and bariatric surgery options for obesity management; and, the importance of long-term weight management. A clinical pathway for adult weight management is delivered by the multidisciplinary team with recognition of the impact of and adjustments needed for other comorbidities. The model allowed for intensification of intervention such as bariatric surgery according to recommendations, patient desires and suitability. A randomised controlled trial is ongoing, with the aim to evaluate standard care (diabetes-focused management) compared with an obesity-related approach with additional dietetic, physiotherapy, psychology and lifestyle advice. Key barriers and enablers to guideline implementation were identified that fall under the following themes: 1) health care delivery changes and the project framework development; 2) capacity and team-building; 3) stakeholder engagement; and, 4) the research project and partnerships. Engagement of not only local hospital but also state-wide health executives and surgical services committee were paramount to the success of the project. Staff training and collective development of the framework allowed for shared understanding. Staff capacity was increased with most taking on other activities (e.g., surgery coordination). Barriers were often related to differences of opinions in focus of the project; a desire to remain evidenced based (e.g., exercise prescription) without adjusting the model to allow for consideration of comorbidities. While barriers did exist and challenges overcome; the development of critical partnerships did enable the capacity for a potential model of obesity care for rural regional areas. Importantly, the findings contribute to the evidence base for models of diabetes and obesity care that coordinate limited resources.

Keywords: diabetes, interdisciplinary, model of care, obesity, rural regional

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